We carried out a comprehensive, unannounced inspection on 7 June 2017. The service was last inspected on 20 December 2016 to follow up a warning notice. The inspectors only looked at well led as part of their inspection and was therefore a focused inspection. They had complied with the warning notice. The last, full comprehensive inspection was in April 2016. During this inspection a number of breaches were identified including: : Regulation 18 Registration Regulations 2009 Notifications of other incidents, Regulation 9 HSCA RA Regulations 2014 Person-centred care, Regulation 11 HSCA RA Regulations 2014 Need for consent, Regulation 12 HSCA RA Regulations 2014 Safe care and treatment and Regulation 18 HSCA RA Regulations 2014 Staffing. We issued a warning notice. At our most recent inspection we found that the required improvements had been made and that the service was no longer in breach of any regulation.

At this inspection there was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The services Oaks and Woodcroft can accommodate up to twelve people in single rooms. There are two bungalows on each site which are adjacent to each other. People had a diagnosis of a learning disability.

The service was well staffed and staff met people’s needs in a timely way. We saw a lot of engagement and people having individual time with staff. Risks were well documented with good guidance for staff to follow to minimise the risk. Training was provided to staff to help them meet people’s individual needs and help to reduce risks.

Staff recruitment files were being updated to demonstrate how the provider was following an effective recruitment process.

Medicines were well managed and people received their medicines as intended. There were robust systems in place to ensure medicines were correctly accounted for and administered by suitably qualified staff.

Staff were supported to recognise the risk of potential or actual abuse and knew what steps to take to ensure people were fully protected.

Staff were well supported through induction and received regular training and supervision of their practice. The staff team were confident in the management of the service and felt listened to and empowered to make decisions.

People were supported to access the kitchen and be involved in food preparation. Staff monitored people’s food and fluid intake to ensure it was sufficient to their needs. Unplanned weight loss was investigated to help ensure the person did not continue to lose weight.

People’s health care needs were documented and in the main met. However we identified gaps in records in relation to the monitoring of a certain healthcare condition.

The Care Quality Commission is required to monitor the operations of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) which applies to care services. People did not have any restrictions and staff acted lawfully to support people.

We found the environment could be improved and would help people to access the outside space if improvements were made. These were made immediately following our inspection.

Staff were caring and knew people well. Staff encouraged people to make individual choices but did not make the best use of technology to help aid communication. Some people did not have verbal skills and staff used limited ways to help them communicate effectively with people.

People were encouraged to be independent and have opportunities but we could not always see if goals set were achieved or if they were of the person’s choosing. We found a number of people at the service very able and questioned the appropriateness of the setting

We carried out an unannounced comprehensive inspection of this service on 19 and 20 April 2016. A breach of the legal requirements was found and a warning notice was issued in respect of this breach. We undertook this focused inspection to check that they had undertaken changes to meet these requirements.

This report only covers the findings in relation to that notice.

We have not changed the overall rating for this service as a result of this inspection, which was only to follow up our enforcement action. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Oaks & Woodcroft on our website at www.cqc.org.uk.

The Oaks & Woodcroft is a care home that provides accommodation and personal care for up to 12 people. There were 11 people living in the home on the day of the inspection.

At the time of the inspection, the home did not have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. The manager currently overseeing the service from another of the providers services had applied to have The Oaks & Woodcroft added to their registration. This application was currently being considered at the time of this inspection. This person has been referred to as the service manager in this report.

At the previous comprehensive inspection effective monitoring systems were not in place to ensure quality and safe care was provided. This had resulted in some people receiving poor care and being at risk of harm.

At this inspection we saw that improvements had been made and that effective systems had been introduced since our last visit. These systems were to monitor the quality of care and the safety of people living at the service, and to reduce the risk of harm and poor care.

The service manager had identified where improvements were needed and had taken action to achieve them. A number of new auditing schedules had been introduced and a number of audits had regularly taken place to identify if any shortfalls had occurred.

The Warning Notice we issued had been complied with.

The Oaks and Woodcroft is registered to provide accommodation and personal care for up to 12 people who are living with learning and physical disabilities. At the time of our inspection there were 11 people living at the service.

This unannounced inspection took place on 19 and 20 April 2016.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager had been away from work for a number of weeks and the service was being overseen by a registered manager from another of the provider’s services.

The provider was not taking appropriate action to manage risks. Risks were not always identified and risk assessments were not reviewed appropriately. Risks around the use of equipment were not identified and action was not taken in a timely way to reduce the risks to people living at the home. Moving and handling techniques were not always in line with current recommended practice.

Staff had an understanding of abuse and safeguarding procedures. They were aware of how to report abuse as well as an awareness of how to report safeguarding concerns outside of the service. Staff undertook safeguarding training providing them with knowledge to protect people from the risk of harm.

Care plans were not up to date; the information within them was not current and was contradictory in some instances. We could not be confident that people always received the care and support they needed.

The Care Quality Commission is required to monitor the operations of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Staff had some knowledge of the MCA and DoLS. Not all DoLS applications required had been submitted.

The service was poorly managed. The provider did not have an effective governance system to monitor the quality of the service and identify the risks to people. Care records were out of date. Effective audits were not being carried out. The provider had not picked up issues that were identified in this inspection.

The provider conducted a survey for people using the service. However we saw no evidence in the records or in the information we reviewed documenting that the survey was made accessible to people in the form of an ‘easy read’ version.

The provider had a recruitment procedure in place. People were supported by staff who had only been employed after the provider had carried out checks. Once employed, however, staff were not supported in their role through regular training and supervision.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.

As the main purpose of this inspection was to assess improvements made in relation to shortfalls identified during our previous inspection in June 2014, we did not request information directly from people using the service on this occasion.

Overall we found that the provider had taken sufficient action to address the shortfalls in relation to record keeping and was now compliant with regulation 20 of The Health and Social Care Act 20018. People’s care records now held up to date information about them, and their needs and risks to their welfare had been reviewed regularly by staff.

A single inspector carried out this inspection. The focus of the inspection was to answer the five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, relatives and staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People living at the home, their relatives and an advocate said that The Oaks and Woodcroft was a good place for people to live. They told us that the staff were kind, friendly and polite and provided the people living at the home with the care and support they needed.

Staff personnel records contained all of the information required by the Health and Social Care Act 2008. This meant that the staff members employed were suitable and had the qualifications, skills and experience needed to support people living at the service.

There was a process in place in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguarding (DoLS). Policies and procedures were held. There had been no reason to submit a DoLS application. Staff had been trained and knew when a DoLS application was needed. The manager knew how to submit a DoLS application.

Is the service effective?

People’s health and care needs were assessed with them or their family member. Specialist dietary, mobility and equipment needs had been identified in care plans when required. Relatives told us their family member received the care and attention they required in a way that met their needs. Through our observations and speaking with staff we noted that the staff understood the care and support needs of each person. One person told us. “This is a nice home and the staff will do anything to help you.” Staff had received training to meet the needs of people living at the home.

Is the service caring?

People were supported by staff who used a kind and attentive approach. We saw that the staff were patient and encouraged people to be as independent as possible. Relatives told us that the staff were sometimes busy but did not rush people. Our observations confirmed this. A visitor told us. “I am happy with the care given to my family member. The members of staff are polite and respectful.”

Is the service responsive?

Care and risk assessments had been completed but not all had been recently reviewed. The care and support provided was adjusted to meet the needs of each person. Improvements were being made to ensure that any change in care and support was recorded in the person’s plans of care. A record was held of people’s preferences, interests and diverse needs. Relatives told us that staff members consulted their family member and encouraged them to make their own decisions. People had access to a range of planned activities that they said they enjoyed.

Is the service well led?

Staff spoken with had an understanding of the ethos of the home and quality assurance processes were in place. Relatives told us that they had been asked for their feedback on the service their family member received. Visitors and staff said that they had felt listened to when they had made a suggestion or raised their concerns. People told us that the manager was approachable.

We undertook this follow up review to determine whether or not improvements had been made to the behavioural management plans of a person using this service and also to health and safety systems.

We were provided with various pieces of information by the manager of the home and found that the necessary improvements had been made.

We were unable to communicate directly with many people living at The Oaks and Woodcroft. To help us understand people's experiences we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experiences of people who could not talk with us.

We observed the care and support delivered during lunch time and found that staff were respectful and encouraged people to eat independently. Staff members positively engaged with the people they were supporting, involving them in conversations and discussing plans for the day. People were enabled to eat at their own pace and offered choice such as what crisps and yoghurts they wanted to accompany their meal.

During our inspection we also saw that people were supported to undertake activities which they enjoyed to do. For example, one person liked table games, such as completing puzzles. We saw that an area had been allocated in the home so the person could enjoy their chosen activity whilst maintaining social contact.

The people we met with during our visit on 19 October 2011 weren't able to tell us verbally about how they were involved in the planning and running of the home. During our visit we noted that staff had a very good understanding of people's individual ways of communicating. We also noted that staff supported people to make choices about what they wanted to do and where they wanted to be.

We saw that people were comfortable and relaxed and some people had chosen to be involved with making a Christmas cake.

One person did tell us that they were very excited about Christmas.

We saw that staff were very knowledgeable with regard to understanding people's various mannerisms and body language, which meant that their individual care and support needs were met consistently.

When we asked staff members if they could change anything at all to make people's lives in the home better, some of the responses and suggestions we received included: Material things, such as décor and carpets, more modern furniture, individual food shopping, a bigger bus and more consistency with communication in the home.

We spoke with two people living at The Oaks and Woodcroft and they both told us that they were happy living there.

We observed staff interacting with the people they were caring for and saw that staff knew the people they were caring for well. For example, they talked with the people about the activities planned for the day. Staff and people living at the service got on well together and we noted a happy, relaxed atmosphere.

However, we were not confident that people’s needs were always appropriately identified and met.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We spent some time touring the building and looking at the general cleanliness. We found that it was generally clean and free from unpleasant odours. The dining room was clean as were bathrooms and toilets.

However, we found that risks in relation to a refurbishment at the premises were not being appropriately managed or monitored.